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PORT PERRY BAPTIST CHURCH

SOCCER CONSENT FORM 2025



Please note: Children must be 3yrs old by May 1, 2025. As well, all children will be placed in age groups based on their age in May

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. Information received is confidential and is being gathered for the purposes of serving your child while in the care of Port Perry Baptist Church. Any medical information collected here serves to authorize Port Perry Baptist Church, and its staff and volunteers, to obtain medical assistance in emergencies.

In the case of custody agreements, please include the proper form authorizing parental contacts.

(1) I/we, the parents or guardians, authorize the Port Perry Baptist Church Ministry Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named above.

(2) I/we, undertake and agree to indemnify and hold blameless the Ministry Personnel, Port Perry Baptist Church, its Pastors, and Board of Elders from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of the Port Perry Baptist Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization are effective only when participating in or traveling to events of the Port Perry Baptist Church.

Today's Date: February 23, 2025




First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Allergies (please list):
EpiPen:*
No
Yes

Restricted foods:
Is your child bringing any medication (other than an Epi Pen) with him/her?*
No
Yes

Does your child have any physical, emotional, mental, or behavioural concerns/imitations that our ministry personnel should be aware of? Please describe in the text box
T-SHIRT SIZE*

Home Church (if any):

How did you hear about Summer Soccer Club?
Would you like to know about other children's programs at Port Perry Baptist Church?*
No
Yes

Request to play on same team as (please limit to one player and provide a first and last name. Please note this is not guaranteed):
Photos I grant permission for the reasonable use of pictures containing my child in any or all of the following ways:
Brochures/Promotional material
Church
Website
Newsletters
During many of our programs food is offered to the children/youth. This can include candy, gum, chocolate, baked goods (home-made and/or store-bought), freezies or chips. If for any reason you DO NOT wish for your child to consume any food products while in our program, please indicate below.*

Special instructions in regards to medical attention

Purposes and Extent

Port Perry Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Port Perry Baptist Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with the above.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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